General Question for the Week of February 26, 2018

General Compliance Question of the Week

Question:

How should we bill Medicare for cochlear devices replaced without cost to the hospital or beneficiary?

Answer:

In November 2016, the Department of Health & Human Services Office of Inspector General (OIG) released a report related to the fact that hospitals did not always comply with Medicare requirements for reporting cochlear devices replaced without cost. (For this report, go to https://oig.hhs.gov/oas/reports/region1/11500508.asp.) Specifically, hospitals did not report the appropriate modifiers and charges or a combination of the appropriate value code and condition codes.

The OIG report gave the following guidelines for outpatient hospitals:

  • For services furnished on or after January 1, 2014, report value code “FD” along with condition code 49 or 50.
  • For services furnished prior to January 1, 2014, report the modifier “FB” on the same line as the procedure code (not the cochlear device code).

The Centers for Medicare & Medicaid Services (CMS) have a list of resources where you can find more about this topic. Go to https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/CochlearDevices-Resources.pdf.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.